| Background:It is reported that compared with healthy subjects, a lower serum testosterone level is more likely to be found in patients with congestive heart failure (CHF), making it an independent risk marker of HF, and relevant with exercise capacity, cardiac function, quality of life and mortality of the patients. Consequently, the supplementation of testosterone, also known as testosterone replacement therapy (TRT), has been considered as an anticipatable therapy for CHF patients. Along with the increasing number of the studies, the consequence of the administration of TRT to CHF patients remains controversial and debatable, leaving the decision making on whether to treat this unfavourable, poor-prognosis disease with testosterone by clinicians with inevitable hesitation.Objectives:We put a meta-analysis on published studies into practice to evaluate the prognosis and effectiveness of testosterone in CHF patients.Methods:We performed a literature search of MEDLINE (Ovid SP and PubMed), EMBASE (Science Direct), the Cochrane Library and reference lists of relevant articles for high-quality randomized placebo-controlled trials focusing on the prognosis and effectiveness of treating CHF patients with TRT by July 2015. Two specialized reviewers were engaged in preliminary data extraction and methodological quality assessment independently. We extracted the characteristics of each included studies and patients distinction, and the primary outcomes and pertinent parameters of interest are as follows:re-hospitalization, HF deterioration, adverse event (AE), left ventricular end-diastolic diameter (LVEDd), left ventricular ejection fraction (LVEF), peak oxygen consumption (Peak VO2), the ventilation/carbon dioxide production (VE/VCO2) slope, functional capacity measured by the 6-minute walk test (6MWT) or incremental shuttle walk test (ISWT), muscle strength measured by hand grip strength, NYHA classification, blood pressure (BP), heart rate (HR), Q-T intervals and BNP. Investigators were contacted for missing information. There was no constraint based on language or publication status. The overall estimates were calculated by a random-effects model or a fixed-effects model, and the possibility of publication bias was evaluated by a funnel plot and Egger’s test. The origins of heterogeneity were investigated by subgroup analyses between the possible risk markers and study characteristics.Main results:Of 2685 retrieved records in total,8 studies, with 340 subjects recruited altogether, conformed to the eligibility criteria and were included in the meta-analysis. Compared with placebo group, the influence of TRT in re-hospitalization and deterioration of CHF patients is limited, but it significantly elevates functional capacity (pooled standardized mean difference (SMD) 2.69 SD,95% CI 0.89 to 4.49, P=0.003) in CHF patients. Based on the results of subgroup analysis, CHF patients obtain benefits in cardiac morphological changes, cardiac function and functional capacity [LVEDd (weighted mean difference (WMD)-0.300 mm,95% CI-0.325 to-0.275, P<0.001), LVEF(WMD 0.100%,95% CI 0.058 to 0.142, P<0.001), functional capacity (SMD 4.14 SD,95% CI 3.41 to 4.86, P<0.001)] from a long-term (>12 weeks) utilization of TRT.Authors’ conclusions:(1) The administration of TRT in CHF patients has no influence in HF re-hospitalization and deterioration;(2) TRT significantly enhances functional capacity of CHF patients;(3) Based on the results of subgroup analysis, a long-term (>12 weeks) utilization of TRT benefits CHF patients in cardiac morphological changes, cardiac function and functional capacity as well.In consideration of the numbers and sample size in the included studies, further substantial studies with larger sample size are required to testify the effectiveness of testosterone on CHF.Background:Along with the enlarged population of the aging and obesity, so the incidence of hypertension advanced to a higher altitude. It is reported that hypertension has become the first risk factor for myocardial infarction, heart failure, stoke, renal insufficiency and other various diseases. Although there are many kinds of antihypertensive drugs available in clinical practice, it remains a difficulty to clinicians, who aim to alleviate the target-organ damages and eliminate the morbidity of cardiovascular events for the hypertensive patients, to choose the optimal and efficient therapy. β-receptor blockers has been used as antihypertensive drugs for many years, whose efficacy is undeniable. Nebivolol, a third-generation β-blocker for hypertension, exhibits its validity in blood pressure management and potential in attenuating the mortality of heart failure patients.Objectives:To evaluate the antihypertensive efficacy of β-receptor blockers and its impact on blood pressure stability, variability, vascular compliance, cardiac diastolic function and metabolic parameters for treating mild to moderate hypertensive patients.Methods:We recruited 20 mild to moderate essential hypertension patients in Qilu Hospital of Shandong University through June 1,2015 to September 30,2015. After primary data collection (including age, gender, body mass index, family history, chronic medical conditions etc.) and a 2-weeks drug clearance period, the patients received the standard examination procedure and 12-weeks antihypertensive therapy. Blood pressure and 24h ambulatory blood pressure monitoring were measured for blood pressure management, blood was tested for metabolic parameters after an overnight fast, and Philips iE33 Doppler diagnosis system was used to assess cardiac diastolic function of these patients. All the patients took the identical examination procedure before and after the 12-weeks antihypertensive therapy. The drug dosage remained the same during the whole intervention. Student’s t test was used for hypothesis examination of all the measurements and parameters.Main results:(1) Antihypertensive efficacy:after 12-weeks intervention, the blood pressure has been significantly lowered by 8.37±13.89/12.14±7.05mmHg (P<0.05), and the mean blood pressure in 24 hours and nighttime have been eliminated significantly (6.60±9.39/6.13±6.90mmHg,11.58±14.12/9.78±9.21mmHg, P<0.05), the daytime diastolic blood pressure has been lowered (4.85±6.75mmHg, P=0.030), however, there was no significant reduction in daytime systolic blood pressure.(2) Blood pressure stability:after 12-weeks intervention, the through to peak ratio (T/P ratio) of systolic and diastolic blood pressure were 0.42 and 0.25 respectively, the smoothness index (SI) were 0.69 and 0.62 respectively. The antihypertensive efficacy of β-receptor blockers had fluctuation and invalidation during 15:00-20:00.(3) Blood pressure variability and vascular compliance:after 12-weeks intervention, there was no influence in blood pressure variability and morning blood pressure surge. The 24h pulse pressure index (24h PPI) was elevated significantly (0.01±0.02, P=0.047), but there was no change in 24h, daytime and nighttime pulse pressure (24PP, d-PP, n-PP).(4) Cardiac diastolic function:after 12-weeks intervention, there was no influence in early peak filling (E), early diastolic tissue velocity (e’) and E/e’of the mitral valve.(5) Metabolic parameters:after 12-weeks intervention, the serum TC, LDL and GLU advanced significantly (0.34±0.48mmol/L,0.20±0.34mmol/L,0.26±0.44mmol/L, P<0.05), and no statistically significance in TG and HDL.(6) Security:the overall adverse event incidence was 15%, mainly manifested as functional capacity reduction.Authors’conclusions:β-receptor blockers significantly reduced blood pressure,24h and nighttime mean blood pressure and elevated vascular compliance in mild to moderate essential hypertension patients, but its antihypertensive efficacy had fluctuation and invalidation, and it may influence metabolic parameters. There was no influence in blood pressure variability and diastolic function. |
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